Optimizing outcomes in antireflux surgery: anticipating GERD symptom resolution after laparoscopic Nissen fundoplication

Although laparoscopic Nissen fundoplication (LNF) is widely regarded as the gold standard for the surgical management of gastroesophageal reflux disease (GERD), identifying the clinical and physiological predictors of successful symptom resolution remains a challenge.This narrative review synthesizes contemporary evidence from randomized trials, cohort studies, and systematic reviews published between 2010 and 2025 to evaluate clinical, physiological, patient-related, and technical predictors of postoperative outcomes after LNF for GERD.Typical GERD symptoms, a positive response to proton-pump inhibitors (PPIs), and objectively confirmed reflux emerge as key predictors of favorable surgical outcomes.Impedance-derived bolus exposure appears to provide greater prognostic value than traditional acid exposure time or the composite DeMeester score, especially in patients with PPI-refractory symptoms.Highresolution manometry parameters, including preserved peristalsis, longer lower esophageal sphincter length, and higher resting pressure, were associated with improved symptom control.In contrast, patient-related factors such as obesity and psychological comorbidities adversely affected the results.From a technical standpoint, meticulous surgical techniques, including tension-free hiatal repair and floppy fundoplication, minimized dysphagia and its recurrence.Collectively, these data suggest that optimizing patient selection through a multifactorial assessment of clinical, physiological, and technical factors can improve surgical outcomes and support evidence-based decision-making in antireflux surgery.